Ebola 2014: Pandemic Preparedness Lessons Learned

In late July and early August many Americans were first learning about the Ebola threat to our nation and families—and we had a lot to learn. For those of us who had read Richard Preston’s Hot Zone (Anchor, 1995), the word Ebola produced frightening images of a deadly and contagious disease that caused organs to dissolve while patients were still alive, and ended in death for more than 90 percent of those infected.

As the first patient arrived in America for treatment, these “facts” were being hyped by cable news outlets as helicopter camera crews followed an ambulance down Atlanta freeways to Emory University Hospital. (I must admit, I was one of the news junkies watching.) However, we should have all realized we had much to learn when Dr. Kent Brantly walked from the ambulance into the hospital under his own power.

We quickly learned that high-quality supportive care can significantly reduce Ebola mortality, and that certain aspects of America’s bio-response capabilities have significant deficiencies. Here is a partial list of the lessons learned from Ebola 2014. They are in no particular order, but the final one may be the most important.

  • Ebola is a horrifying disease that is causing major public health, social, economic, political and security problems in West African nations. It is also an international public health threat that requires a unified international response, but as predicted in August by Dr. Tom Frieden, the Director of CDC, Ebola is not a serious public health threat to the United States.
  • The best strategy for protecting American families from Ebola is to focus efforts (spending) on West Africa, including the use of the U.S. military for what it does best: logistics, communications, transportation and organizing international relief efforts.
  • The Food and Drug Administration has demonstrated remarkable flexibility in rapidly responding to requirements for Ebola medical countermeasures (diagnostic tools, vaccines, and therapeutics). This was partially due to the fact that a lot of basic science and advance development research has been underway for a decade with funding for defense against bioterrorism. This is the dual-benefit aspect of spending on biodefense—improvements in rapid diagnostics, the ability to produce vaccines and therapeutics faster and less expensively, improved capacity for surge medical care are good for defense against bioterrorists, but also for defense against naturally-occurring diseases.
  • However, erratic funding for research and development of medical countermeasures (basic science, advance development and regulatory science) has caused serious delays in many programs critical to biodefense. Investments in medical countermeasures (MCMs) must be made years before the pandemic, not during it. MCMs are similar to sophisticated military weapon systems, they have very long lead times for development and deployment.
  • America does not have the capability to rapidly produce medical countermeasures in a crisis. Even if one of the Ebola candidates currently in testing proves to be a “silver bullet” as a vaccine or therapeutic, America does not the capacity to rapidly produce significant quantities. We need to understand that in the 21st century, America’s pharmaceutical and biotech industries are part of our defense industrial base. Today, more than 80 percent of the active pharmaceutical ingredients in prescription drugs sold in America are made in Asia. (Would we allow China to make our next-generation fighter jet?)
  • The federal government needs a single leader with authority, responsibility, and accountability for pandemic preparedness and response. Today, these three leadership issues are spread out among more than two dozen presidentially-appointed, Senate-confirmed individuals in more than dozen departments and agencies. Not one of these leaders has pandemic preparedness and response as a full time job. It is like an NFL team with 24 assistant coaches, but no head coach. Do you think this team would make it to the Super Bowl?
  • America needs significant improvements in the ability of federal, state and local governments to work in unison during any major disaster, including public health. There were many stumbles during the early response (or as they say in DC, mistakes were made). This lack of coordination could be catastrophic during a major pandemic.
  • State and local public health departments will always be the frontline of our pandemic response capabilities. Since 2008, reduced federal funding has driven a 20 percent reduction in public health personnel at the state and local level.
  • We must improve messaging. Leaders need to be open and honest with the American public. One sentence from President Obama on September 16th caused many problems with public confidence.
    • “First and foremost, I want the American people to know that our experts, here at the CDC and across our government, agree that the chances of an Ebola outbreak here in the United States are extremely low.”
    • I am sure that the people who wrote this sentence for the President knew what they meant by the word “outbreak”, but the American public did not, particularly when two weeks later Ebola came to Dallas.
    • It would have been far better for the President to say that in the 21st century, disease can come to America from the most remote corners of the world within hours; however, Ebola is not the type of disease that could rapidly spread in America.
    • It would have also been helpful for political and public health leaders in federal, state and local governments to say that there will be a learning curve as we deal with this new threat—as we saw during the SARS epidemic of 2003—a deadly contagious disease that was contained. There will likely be some mistakes, but we will admit them and take immediate action to correct them and make sure that all public health and medical personnel are informed.
    • Ron Heflin, Program Manager NASA Space Shuttle, set the example for senior government leaders to follow on February 1, 2003. During the first press conference after the breakup of the space shuttle Columbia, he said: “We wanted to meet with you and be as fair and open with you given the facts as we understand them today. We will certainly be learning more in the coming hours, days and weeks. We will tell you as much as we know, and we will be as honest we can with you and will certainly try to fill in blanks in the coming days and weeks.”

Bottom line: During the past 30 years, we have seen at least a dozen newly-emerging diseases come to America each decade. As the world becomes more crowded and jet travel makes it smaller, this trend is likely to increase. We should learn the lessons from Ebola 2014 and consider it a wake-up call for pandemic preparedness.

_________________________________________

Colonel Randall Larsen, USAF (Ret) is the national security advisor at the UPMC Center for Health Security and the former executive director of the bipartisan Congressional Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism.

 

About biosecureblog

Colonel Randall Larsen, USAF (Ret) -CEO, WMD Center -former Executive Director, Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism -former chairman, Department of Military Strategy and Operations, National War College
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